Sedation Dentistry (Analgosedation): Treatment Without Fear

For some patients, a trip to the dentist is not an inconvenience you put up with and then forget. Pronounced fear, anxiety or dental phobia can lead to dental visits being postponed for years, sometimes for decades, until pain or a broken tooth finally forces the issue. By then a far larger procedure is often needed than would have been required at the outset. Analgosedation exists precisely for these patients, but also for everyone who simply wants to get through a longer or more extensive procedure calmly, without tension in the body and without a memory that stays with them as a burden.

Analgosedation can range from lighter sedation, in which the patient is relaxed, able to communicate and follow instructions but feels no fear, has no usual sense of time passing and often remembers little of the procedure afterwards, through to deeper analgosedation, in which the patient effectively sleeps through the procedure. Throughout, the patient breathes spontaneously and, depending on the depth of sedation, may respond to speech or to a stimulus. That is one of the important differences between analgosedation and general anaesthesia.

At Ortoimplant DENTAL SPA in Zagreb we apply potentiated intravenous analgosedation as a matter of protocol for more extensive implant and oral surgery procedures. Combined with local anaesthetic and the supervision of an anaesthesiologist, it allows us to carry out even long and demanding procedures without pain and without fear, while patients often effectively sleep through them and remember little or nothing afterwards.

What analgosedation is, and what it is not

Analgosedation is a combination of two effects: analgesia, meaning control of pain, and sedation, meaning calming and relaxation. The depth of sedation can range from mild and moderate, known in the professional literature as conscious sedation, through to deeper sedation. At the lighter levels the patient is conscious, breathes independently and can respond to speech and follow instructions, while at deeper levels of analgosedation the procedure can effectively be slept through. During analgosedation the level of fear, anxiety and tension is considerably reduced, and memory of the procedure is often partly or entirely absent.

One distinction matters here. Local anaesthetic removes pain, but it does not remove fear. Someone who is afraid of the needle, of the sound of the drill or simply of the feeling of losing control can still be tense, with a racing pulse, even when they feel no pain. Analgosedation acts on exactly that layer: on the experience, not only on the sensation. This is why local anaesthetic and analgosedation are not mutually exclusive but are used together, so that pain, fear and anxiety are controlled during the procedure and the patient is as comfortable as possible.

General anaesthesia is something else. The patient is in a controlled state of unconsciousness and requires a different level of support and monitoring of vital signs. Analgosedation allows the depth of sedation to be matched to the patient and the procedure, with independent breathing preserved, and as a rule allows a faster recovery than general anaesthesia.

How common fear of the dentist actually is

Fear of the dentist, dental anxiety and dental phobia are not rare. An extensive systematic review and meta-analysis published in the Journal of Dentistry estimated that roughly 15.3 per cent of adults worldwide have pronounced fear or anxiety connected with dental care, with a higher frequency among women and younger adults. The authors also showed that fear affects how regularly people see a dentist and, as a consequence, the state of their oral health.¹

This is a link we see constantly in practice. Fear leads to avoidance, avoidance to steadily worsening teeth, and that often to the need for larger and more demanding procedures which can reinforce the very same fear. Analgosedation is one way of breaking that cycle: so that even an extensive procedure passes calmly, without pain and without fear, and so that the next dental appointment is no longer an experience the patient wants to avoid.

Types of sedation used in dentistry

There is no single type of sedation for all patients and all procedures. The route of administration and the depth of sedation are matched to the patient’s state of health, to the level of fear or anxiety, and to the type, extent and duration of the procedure. Three approaches are used most often in dentistry.

• Inhalation sedation with nitrous oxide. Also known as laughing gas, it is administered by breathing in a mixture of nitrous oxide and oxygen through a nasal mask. It acts quickly, the depth of sedation can be adjusted during administration, and the effect wears off rapidly once it is stopped. A systematic review and meta-analysis in the Journal of Dental Anesthesia and Pain Medicine reported an overall success rate for nitrous oxide and oxygen sedation of 94.9 per cent in a sample of 1,293 patients.²
• Oral sedation. A sedative medicine is taken by mouth, usually before the procedure. It can be used in patients with fear or anxiety when this form of sedation is appropriate for the planned procedure. A systematic review published in BMJ Open showed that some orally administered sedatives can reduce dental anxiety, with the effect and possible side effects depending on the chosen drug and dose.³
• Intravenous sedation. Sedatives and other necessary medicines are given directly into a vein, which allows the depth of sedation to be adjusted in a controlled way during the procedure. It is particularly suited to longer and more extensive procedures and to patients with pronounced fear or dental anxiety, with continuous monitoring of vital signs.

At Ortoimplant DENTAL SPA we apply potentiated intravenous analgosedation under the supervision of an anaesthesiologist as a matter of protocol for more extensive implant and oral surgery procedures. The depth of analgosedation is matched to the patient and the procedure, and during extensive procedures patients often effectively sleep through them and remember little or nothing afterwards.

Before analgosedation we take a detailed medical history and assess general health, the medicines the patient takes, the type and duration of the planned procedure and other factors important for carrying out analgosedation safely.

What a procedure with analgosedation looks like with us

It all begins with a conversation. At the first examination, which is free of charge with us, we go through medical history, medicines, allergies and previous experiences at the dentist. For patients who arrive with pronounced fear, anxiety or dental phobia, that conversation is often especially important: when a patient knows what is coming and feels in control, some of the tension eases before anything has even started.

For more extensive implant and oral surgery procedures at Ortoimplant DENTAL SPA we apply potentiated intravenous analgosedation under the supervision of an anaesthesiologist as a matter of protocol. The medicines are given intravenously, and the depth of analgosedation is matched to the patient and to the course of the procedure. The patient breathes independently while their vital signs are continuously monitored. Depending on the depth of analgosedation they can communicate and respond to speech or to a stimulus, and at deeper levels of analgosedation they often effectively sleep through the procedure. The sense of time passing is altered, and after the procedure patients often remember very little or do not remember the procedure itself at all.

Local anaesthetic is used alongside analgosedation and provides pain control in the area being treated. In this way we can carry out even long and demanding implant procedures without pain and without fear, with maximum comfort for the patient.

After intravenous analgosedation the patient remains under supervision during the initial recovery. Because of the effect of the medicines given, they must not drive themselves after the procedure, and they receive instructions on what to do after analgosedation in advance, tailored to their state of health and to the procedure carried out.

Who analgosedation helps most

Analgosedation is not needed for every dental procedure, but there are situations in which it plays a particularly important role. At Ortoimplant DENTAL SPA we apply potentiated intravenous analgosedation as a matter of protocol for more extensive implant and oral surgery procedures, and it is also particularly useful for patients with pronounced fear, dental anxiety or dental phobia.

Analgosedation helps most:

• patients with pronounced fear, dental anxiety or dental phobia, because of which they may have put off going to the dentist for years
• during long and extensive implant and oral surgery procedures, because a calm, relaxed patient gets through the procedure more easily and more peacefully, without fear and with maximum comfort. At the same time, the absence of tension and unexpected movement on the patient’s part gives the surgeon more stable conditions for calm, precise work, which matters for the safety of the patient as well
• patients with a strong gag reflex, which can make certain dental procedures difficult or impossible to carry out
• patients who find it hard to stay still for longer periods or who tolerate the sounds, sensations and other stimuli associated with dental treatment particularly badly

Even so, analgosedation is not suitable for every patient, nor is it carried out without a prior assessment of the patient’s state of health. Certain illnesses and medical conditions, pregnancy, respiratory disease and some medicines can influence the decision on whether and how it is used. This is why we approach each patient individually, with a detailed medical history and an assessment of the factors important for carrying out analgosedation safely.

Safety and the limits of the method

Sedation in dentistry has a good safety profile when it is carried out in properly selected patients, with a prior assessment of their health, appropriate monitoring and a trained medical team. Even so, it is important to be precise when talking about the evidence. A recent systematic review and meta-analysis published in the journal Medicina compared nitrous oxide sedation with other sedatives and found no significant differences in patient satisfaction or in the successful completion of procedures, while the authors cautioned that a firm assessment of safety was limited by the amount of available data on side effects.⁴

At Ortoimplant DENTAL SPA, potentiated intravenous analgosedation for more extensive implant and oral surgery procedures is carried out with continuous monitoring of the patient’s vital signs by an anaesthesiologist throughout the procedure. Before the procedure we take a detailed medical history and assess the patient’s health, the medicines they take, allergies and other factors important for carrying out analgosedation safely. The depth of analgosedation is matched to the patient and to the course of the procedure.

No medical procedure is entirely without risk, and analgosedation is no exception. That is precisely why safety does not begin with giving a sedative, but with a proper assessment of the patient before the procedure, the choice of an appropriate depth of analgosedation, continuous monitoring of vital signs by an anaesthesiologist during the procedure, and observation of the patient during the initial recovery.

Analgosedation and extensive procedures

Analgosedation is particularly important during long and extensive implant and oral surgery procedures, in which even a patient without pronounced fear or dental anxiety would find it difficult to stay completely still and relaxed for hours. This includes complex implant and oral surgery, All-on-X treatments and advanced implant techniques for patients with a marked lack of jawbone.

In procedures like these, analgosedation is not only a question of comfort. A calm, relaxed patient without fear or tension gets through a procedure lasting several hours more easily, while the absence of unexpected movement gives the surgeon stable conditions for calm and precise work. That matters especially in demanding surgical procedures where precision and controlled working conditions are important for the safety of the patient as well.

This is why, at Ortoimplant DENTAL SPA, we apply potentiated intravenous analgosedation as a matter of protocol for more extensive implant and oral surgery procedures. It is part of a broader approach in which we do not look at the patient through the surgical procedure alone, but also take care of their comfort, the preparation of the body and the recovery. DENTAL SPA treatments accompany the patient before, during and after the procedure and are tailored individually to their needs.

Frequently asked questions